功能性电刺激对脑卒中足下垂患者步行矫正效果的系统评价

Orthotic Effect of Functional Electrical Stimulation on the Improvement of Walking in Stroke Patients with Foot Drop: A Systematic Review

目的系统评价功能性电刺激对脑卒中足下垂患者步行的矫正效果。方法计算机检索PubMed、Web of Science、e Cochrane Library(2013年第1期)、EMbase、CBM、CNKI、VIP和WanFang Data等数据库,收集功能性电刺激对脑卒中患者足下垂矫正效果的随机对照试验(RCT),检索时限均为2000年1月～2013年1月,并追溯纳入研究的参考文献。由2位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入8个RCT,255例患者。4个RCT的合并分析结果显示,与常规治疗相比,功能性电刺激能提高脑卒中足下垂患者的步行速度,两组差异有统计学意义[MD=0.09,95%CI(0.00,0.18),P=0.04],其余指标因数据不全仅作相应的描述性分析。结论功能性电刺激能提高脑卒中足下垂患者步行速度,但其他指标疗效尚不能确定,尚需更多高质量、大样本、多中心的RCT结果证实。

Objective To systematically evaluate the orthotic effect of functional electrical stimulation （FES） on the improvement of walking in stroke patients with foot drop. Methods The randomized controlled trials （RCTs） that investigated the orthotic effect of FES on walking in stroke patients with foot drop were electronically searched in the da- tabases such as PubMed, Web of Science, The Cochrane Library （Issue 1, 2013）, EMbase, CBM, CNKI, VIP and WanFang Data from January 2000 to January 2013, and the relevant references of included papers were also manually searched. Two reviewers independently screened the trials according to the inclusion and exclusion criteria, extracted the data, and assessed the methodology quality. The meta-analyses were performed using RevMan 5.1 software. Results A total of 8 RCTs involving 255 patients were included. The results of meta-analyses on 4 RCTs showed that, compared with the con- ventional rehabilitation intervention, the functional electrical stimulation could significantly improve the walking speed, with significant difference （MD=0.09, 95%CI 0.00 to 0.18, P=0.04）. The other indicators were only descriptively analyzed due to the incomplete data. Conclusions Functional electrical stimulation is effective in improving walking speed, but it is uncertain of other therapeutic indicators. So it should be further proved by conducting more high quality, large sample and multi-center RCTs.